People were dying . . . and we couldn’t do anything

THE memory of a full hospital ward with floor beds as patients waited for destiny is still fresh in his memory.

Doctor Nyasha Masuka still remembers what he calls the horror days of certain death at the height of the HIV and AIDS pandemic.

A public health specialist, who is also the Provincial Medical Director for Matabeleland North who started to practise at the height of HIV and AIDS pandemic recounts the horrific days back in 2001 when they had to watch people die of full blown AIDS.

Going down memory lane in an interview with H-Metro on the sidelines of the 67th World Health Organisation regional committee for Africa in Victoria Falls last week, he said the vivid memories still haunt him although scientific interventions over the years give him hope.

• Horrific days of HIV and AIDS

“I graduated in 1998 and worked in a district hospital in Beitbridge for 10 years from 2001 and 2011 and during those days, the HIV and AIDS pandemic was at its peak and in the absence of any treatment, those were the most difficult times one could start practising.

“I’m just recounting my memories of the horrific times that I went through as a practitioner during the height of the HIV epidemic.

“The memories are still vivid and that was the most difficult time, when you would just counsel relatives and prepare them for the death of their loved ones,” says Dr Masuka.

The public health specialist, who has been practising for 20 years, recollects how it was certain that if one had been diagnosed with HIV, they were surely going to die.

“Before then there were no antiretroviral drugs and it was a sure case that if you diagnosed anybody with HIV and AIDS, you were simply going to watch them die. I have attended to a lot of patients, and watched them develop full blown AIDS, a lot of opportunistic infections, meningitis, karposi sarcoma, tuberculosis and other cancers.

“All you could do was a ward round, continue supportive treatment, trying to manage the symptoms and pain and nothing else.

“These people were dying and we would even have floor beds, they were dying in numbers and there was nothing you could do to save these lives as a practitioner.”

• Introduction of antiretroviral treatment

“Then around 2002-2003 just across the border in South Africa, they started using a combination of two anti-retroviral treatment, thus lamuvidine and stavudine.

“Because I also ran a private practise in Beitbridge, I started prescribing that combination to my patients who could afford to buy.

“The patients started improving remarkably and they were now up and about their business. But then those who could not afford continued to die.

“I had about 20-25 patients that were on that combination from my private practise and they all remarkably improved,” chronicles Dr Masuka.

He recounts how the national ART programme was then introduced in 2004 and the drastic improvements that came with more people being enrolled on ART.

“Then in 2004, the country’s ART programme started and more people were initiated on ART. There was a drastic change from the horror days of death to less hospital admissions as people quickly responded to ART.

“We started seeing people on ART improving and going back to work, living productive lives something that we never thought of when there was no ART.

“All the symptoms started going away; bed occupancy started getting better say around 2008 as the ART programme improved. There was a remarkable achievement that was made due to the roll out of this ART programme.

“By the time I left Beitbridge in 2011, they had between 8 000- 9 000 people on ART and the majority of them were improving remarkably.”

Dr Masuka says having practised in both eras before the introduction of ART and after the introduction, was an eye opener for him.

“I think for me it has been an eye opener in the profession having a new disease starting in the time that I started practising, see full scientific interventions for that same condition that had wrecked havoc to a time when it is no longer an issue and now just being treated as any other chronic disease.”

• Increased risk behaviour
As the horror days of full blown AIDS came to an end due to the success of the ART programme, 30 years since the HIV pandemic was discovered, Dr Masuka argues that the country is now starting to have increased risk behaviour issues and most of these challenges are coming from the younger generation who did not see what other generations witnessed.

He fears these challenges could derail the gains that were made over the decades by scientific interventions.

“Due to the success of ART, we have a generation that lacks a clear picture of what HIV and AIDS is and because of that lack of appreciation, we have so much risk behaviour that is taking place.

“We have people, who were born when ART was at work, and do not think that HIV is an issue as they can always go on treatment and live productive lives. Because ARVs work so well, people do not seem to be concerned anymore with prevention as they know that they can get treatment especially now that we have a test and treat.

People are no longer worried about HIV prevention because they are certain that there are medicines that work and if I’m infected, I can just be enrolled like any other person and now with test and treat where we don’t even wait for a suppressed viral load.”

• Why men die early of HIV
With emerging research revealing that men with HIV were dying earlier than women, Dr Masuka says while the natural progression of HIV is not like that, he cited that there were a lot of factors that contributed to that.

“The underlying factor is that of adherence and the poor health seeking behaviour among men hence ARVs fail to take full effect on patients due to delay in seeking care which allows the disease to further weaken the system.

“In Hwange district, where we have a viral load machine, results revealed that there is a significant difference of viral load suppression between men and women, with a reduced viral suppression in men.

“We further sought to find out why we had such results; the main issue was that of adherence, poor health seeking behaviour, substance abuse, stigma and issues to do with food insecurity.

“But the major issue being adherence, so our key message is adherence.”

• Why Matabeleland has a high HIV prevalence
Dr Masuka argues that his province and Matabeleland South had the highest HIV prevalence in the country due to migration that leads to prolonged conjugal separation that can lead to risk behaviour as a lot of things can happen during the separation.

“Migration is the major problem we face in these provinces and we all know the consequences of prolonged conjugal separation.

“One of our problematic districts is Bubi where we have resettled people and STI incidences are very high.

• A case of Binga
He adds that one of the districts in the red province has the lowest HIV prevalence in the country noting that it could be a case of preserving cultural values.

“So Matabeleland North is very interesting, we are one of the provinces with a high HIV prevalence but within the same province, we have Binga district with the lowest HIV prevalence in the country.

“Binga is tight-knit closed and polygamous community but has a low HIV prevalence and I guess the protection of cultural values has made sure that prevalence remain very low.”

• Can Zimbabwe end AIDS by 2030?
Having seen scientific interventions saving the country from the horrific days, he believes Zimbabwe can end AIDS by 2030 although he argues that there was need to come up with better tested messaging for communities to drive social behaviour change.

“Social behaviour change communication interventions should continue. My problem is that we are coming up with untested messaging and interventions for communities which we really do not know if they work.

“There is need to do studies and come up with messages and interventions that suit a particular community. The messaging that we are doing is not effective enough for behaviour change and a lot of people are also under the impression that HIV is no longer an issue.

He added that programmers should work with traditional leaders to drive messages giving an example of Binga where chiefs and headman were used to spearhead the male involvement in the prevention of mother-to-child transmission of HIV programme.

“About 70 percent of men in Binga attended antenatal care with their wives and it because the DMO engaged chiefs and headmen in that district, putting them at the forefront of the campaign.

“These are some of the interventions that have been tested and proved to work.”
Dr Masuka dreams of a Zimbabwe where HIV and AIDS will no longer be an issue, in memory of all the lives that were lost at the height of the pandemic.